Set up electronic claim/RA file sharing
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that all health care providers and payers must use the X12 5010 version to exchange EDI business data.
Electronic data interchange (EDI) setupWe accept ANSI X12 EDI files through a direct connection with Clearinghouses that use Secure File Transfer Protocol (SFTP).
Priority Health doesn't publish companion guides, as we strictly adhere to HIPAA standards. Refer to Products I X12.
Electronic Remittance Advice (835)
To receive the 835 payment/remittance advice electronically, complete this form
Service receipts summarize the number of claims submitted to Priority Health, including upfront rejections. They're sent directly to your office by email or fax as selected by your office. The report lists any claims rejected up front for invalid or missing data elements.
To receive service receipts electronically, complete this form:
Transaction types available for EDI
- 270, Eligibility requests, batch and real time
- 271, Eligibility responses, batch and real time
- 276, Claim status requests, batch and real time
- 277, Claim status responses, batch and real time
- 277CA, Claim acknowledgment
- 278, Authorizations
- 834, Group enrollment
- 835, Payment/Remittance advice
- 837P, 837I and 837D, Claims
- 999, Functional acknowledgements
Real-time transaction exceptions
Eligibility and claim status transactions are both available 24/7, with these exceptions:
- Regularly scheduled maintenance periods, which occur on the second weekend of each month.
- Non-routine downtime periods, which are published a week in advance.
- Unscheduled downtime periods, which are communicated within an hour directly to clearinghouses and/or trading partners who utilize real time services.
Questions / Updating your EDI setup
Have questions? Need to change your EDI setup? Contact our EDI team via email at firstname.lastname@example.org.
Contact your software vendor or data clearinghouse for payer IDs not listed below.
- Billing & payment
- Procedures & services
- Reviews & appeals
- Medical policies
- Provider forms
- Seeing Cigna members
- Requirements & responsibilities
- Clinical resources
- Fraud, waste & abuse policy
- Join our networks
- Check patient eligibility
- Data exchange
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status